Provider Demographics
NPI:1932804606
Name:WARD, ADAM TIMOTHY (LPN)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:TIMOTHY
Last Name:WARD
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 LAMBERT DR APT A
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3611
Mailing Address - Country:US
Mailing Address - Phone:757-814-6415
Mailing Address - Fax:
Practice Address - Street 1:115 LAMBERT DR APT A
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3611
Practice Address - Country:US
Practice Address - Phone:757-814-6415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN076509164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse